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Which of the following client complaints should prompt a clinician to order a diagnostic workup for multiple myeloma?
A) “Lately my bones just seem to ache so badly, and nothing seems to help.”
B) “Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going.”
C) “I feel so weak, and the last few days I've actually fallen asleep on my coffee break at work.”
D) “I vomited yesterday evening, and it looked like coffee grounds mixed with some fresh blood.”
A
Bone pain is the most characteristic symptom of multiple myeloma. Joint stiffness is unlikely. Lethargy and bleeding may also result from the disease, but these symptoms are less specific to multiple myeloma.
In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis?
A) Pericarditis
B) Endocarditis
C) Myocarditis
D) Vasculitis
B
The endocardium is a thin, three-layered membrane that lines the heart and covers the valves; infection of this part of the heart is consequently referred to as endocarditis.
When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:
A) Strength of the right ventricular pump to move blood
B) The amount of blood the heart pumps each minute
C) The amount of blood pumped out of the heart with each beat
D) The volume of blood stretching the heart muscle at the end of diastole
B
Cardiac output, which is the major determinant of cardiac performance, reflects how often the heart beats each minute (heart rate) and how much blood it ejects with each beat (stroke volume). Preload reflects the volume of blood that stretches the ventricle at the end of diastole, just before the onset of systole.
A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:
A) Surgery to remove the saphenous vein
B) Percutaneous transluminal angioplasty and stent placement
C) Injection of a potent anticoagulant into lower leg veins
D) Whirlpool therapy with tight wrapping of lower legs immediately following
B
Treatment includes measures directed at protection of the affected tissues and preservation of functional capacity. Percutaneous or surgical intervention is typically reserved for the client with disabling claudication or limb-threatening ischemia. Surgery (i.e., femoropopliteal bypass grafting using a section of the saphenous vein) may be indicated in severe cases. Percutaneous transluminal angioplasty and stent placement, in which a balloon catheter is inserted into the area of stenosis and the balloon inflated to increase vessel diameter, is another form of treatment.
The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis. While educating this teenager, the nurse emphasizes that infectious mononucleosis is caused by which pathogen and usually transmitted via:
A) Heterophil antibodies; blood
B) Epstein-Barr virus; saliva
C) T-cell infection; plasma
D) Bacterial infection; monocytes
B
Infectious mononucleosis is caused by Epstein-Barr virus and is commonly transmitted through saliva. Once the B cells are infected, mononucleosis is diagnosed by the presence of heterophil antibodies in the blood. Infectious mononucleosis is a B-cell viral infection. Cytotoxic T cells attack the virus and limit the number of infected B cells without eliminating them.
The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses?
A) Stable angina
B) Non–ST-segment elevation MI
C) ST-segment elevation MI
D) Unstable angina
A
The fixed or stable plaque is commonly associated with stable angina, and the unstable plaque is implicated in unstable angina and myocardial infarction (MI).
Congenital heart defects can cause a right heart–to–left heart shunting of blood that results in increased:
A) Pulmonary blood volume
B) Right ventricle workload
C) Unoxygenated blood flow
D) Right atrial blood volume
C
Right-to-left shunts transfer unoxygenated blood from the right side of the heart to the left side, diluting the oxygen content of blood that is being ejected into the systemic circulation and causing cyanosis. Left-to-right shunts cause recycling of blood through the pulmonary vessels and the right side of the heart, causing increased volume and workload of the right side of the heart and pulmonary circulation.
The most important complication of atherosclerosis that may cause occlusion of small heart vessels is:
A) Ulceration
B) Thrombosis
C) Fatty streaks
D) Fibrous plaque
B
Thrombus formations on complicated atherosclerotic lesions are the result of sluggish blood flow and turbulence in the ulcerated plaque region. Fatty streaks are preatherosclerotic plaque changes in vessels. Fibrous plaque is part of the atherosclerosis formation, not a complication of it.
A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?
A) Auscultating the client's lungs
B) Palpating the client's lymph nodes
C) Assessing the client's cranial nerve reflexes
D) Assessing the client for bone pain
B
In cases of infectious mononucleosis, the lymph nodes are typically enlarged throughout the body, particularly in the cervical, axillary, and groin areas. Palpation of these nodes is a priority assessment in cases of suspected mononucleosis. Bone pain, adventitious lungs sounds, and abnormal cranial nerve reflexes do not accompany mononucleosis.
A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node
C
The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial depolarization is represented by the P wave and ventricular depolarization by the QRS complex. The isoelectric or zero line between the P wave and the Q wave represents depolarization of the AV node, bundle branches, and Purkinje system.
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to “an enlarged heart.” Which of the following disorders was the player's most likely cause of death?
A) Takotsubo cardiomyopathy
B) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
C) Hypertrophic cardiomyopathy (HCM)
D) Dilated cardiomyopathy (DCM)
C
The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular arrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is:
A) Edema
B) Calf pain
C) Varicosities
D) Strong pulse
B
The primary symptom of chronic obstructive arterial disease is pain with walking or claudication. Typically, persons with the disorder complain of calf pain because the gastrocnemius muscle has the highest oxygen consumption of any muscle group in the leg during walking. The extremity will be thin, dry (no edema), and have weak low-pressure pulses due to severely reduced blood flow to the distal vessels.
Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the client's diagnosis?
A) The presence of a Philadelphia chromosome
B) Down syndrome
C) Radiation exposure
D) Exposure to the Epstein-Barr virus
A
Chronic myelogenous leukemia develops when a single, pluripotent hematopoietic stem cell acquires a Philadelphia chromosome. Down syndrome and radiation exposure are associated with acute leukemias, and exposure to the Epstein-Barr virus is not implicated in the etiology of leukemias.
A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:
A) Cardiomyopathy
B) Pericarditis
C) Pulmonary hypertension
D) Pericardial effusion
B
Pericardial effusion is the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory reaction. It may develop with neoplasms, cardiac surgery, or trauma. Pericardial effusion exerts its effects through compression of the heart chambers. The normal pericardial space contains about 15 to 50 mL of fluid. Increases in the volume of this fluid, the rapidity with which it accumulates, and the elasticity of the pericardium determine the effect that the effusion has on cardiac function. This leads to cardiac standstill or failure. Pericardial sac thickening due to inflammation can restrict the heart, rather than to allow stretching. Rupture of the sac is pathologic, resulting in heart expansion. A friction rub sound (rubbing between the inflamed pericardial surfaces) is characteristic of acute pericarditis. Acquired cardiomyopathies include those that have their origin in the inflammatory process (e.g., myocarditis), pregnancy (peripartum cardiomyopathy), and stress (takotsubo cardiomyopathy). In congenital heart defects, in most cases, pulmonary vascular resistance is only slightly elevated during early infancy, and the major contribution to pulmonary hypertension is the increased blood flow.
List some symptoms of Right and Left sided Heart Failure
Right
peripheral issues
Left
pulmonary issues
Pancytopenia is a deficiency of: (select all that apply)
A) RBC
B) WBC
C) Platelets
D)agranulocytes
A, B, and C
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences?
A) Backup of blood from the right atrium into the superior vena cava
B) Backflow from the right ventricle to the right atrium during systole
C) Inhibition of the SA node's normal action potential
D) Backflow from the left ventricle to the left atrium
D
The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
Conduction of the heart
internodal pathway
AV node
Bundle of His
Bundle Branches
Purkinje fibers